Nail dermoscopy in recent years has become an auxiliary noninvasive tool for the diagnosis of nail diseases. It detects the differentiating characteristics of the nail units and assesses in the management of nail diseases. Dermoscopy may not be a diagnostic tool for all nail diseases; however, it is very useful for early observation with high magnification. This article discusses the important and common dermoscopic manifestations of nail disease cases in the daily practice. Currently, the indications of dermoscopy include viral, bacterial, fungal, inflammatory, pigmented, traumatic nail diseases, nail tumors, and connective tissue disease.

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Terra firma-forme dermatosis is a rare acquired keratinization disorder. Patients present with dirt-like brownish plaques on the neck, trunk, and limbs. It is often confused with dermatitis neglecta, confluent and reticulated papillomatosis, and acanthosis nigricans. Reportedly, it affects children, but genital involvement is rare. We describe three cases of uncircumcised boys with genital involvement, two of which had extragenital involvement. They all had good hygiene. Two underwent skin biopsy, and pathological examination showed papillomatosis and alternating keratinization in the stratum corneum. The disease can be diagnosed clinically by wiping off the lesions with 70% isopropyl alcohol pads, instead of water or soap.

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Background: C-reactive protein to albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in many inflammatory diseases. Objectives: In this study, we aimed to investigate whether there is a correlation between CAR value and disease severity in patients with psoriasis. Methods: The study included 70 plaque-type psoriasis patients and 67 healthy controls. CAR value was calculated after C-reactive protein (CRP) and albumin analysis was performed, Psoriasis Area and Severity Index (PASI) scores were documented. CAR value was compared with PASI scores in patient group. White blood cell count, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, erythrocyte sedimentation rate (ESR), and mean platelet volume and CAR values were compared among these groups. We investigated the most significant parameter for disease severity. In addition, to detect relationship between CAR, disease duration and patients' age and healthy controls, correlation analysis was performed. Results: The median CAR value was found statistically significant higher in the patient group than in the control group (P < 0.001). A significant difference of median CRP, albumin, CAR (all P values are <0.001) and ESR (P = 0.024) were found among the three groups which were arranged according to the severity of the disease. Among these parameters, CAR was found as the most associated parameter with the severity of psoriasis using receiving operator characteristic analysis. Conclusion: CAR value could be a useful parameter for evaluating disease severity, management of disease activity, and follow-up strategies.

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Immune checkpoint inhibitor-related Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) were rarely reported. We summarized the courses and the characteristics of two cases. The first case was a 74-year-old woman receiving pembrolizumab for Stage 2 urothelial cell carcinoma of the bladder. SJS developed 27 days after the first dose of pembrolizumab. The other case was a 67-year-old woman receiving atezolizumab for Stage 4 renal urothelial cell carcinoma. TEN developed after the eighth cycle of atezolizumab. Both patients were treated with low-dose corticosteroid and supportive management. Their wounds healed without dermatologic sequelae.

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Porokeratosis is characterized by keratotic papules or plaques with a ridge-like border. Both disseminated superficial porokeratosis (DSP) and disseminated superficial actinic porokeratosis (DSAP) manifest as numerous, small, round maculopapules with thin thread-like elevated border but differ in their distribution of lesions and the association with sunlight exposure. To analyze and compare the clinical features of DSP and DSAP, we conducted this hospital-based retrospective study. A total of 39 patients were recruited, including 19 DSP patients and 20 DSAP patients. The median age of diagnosis of DSP and DSAP patients was 63 years and 59 years, respectively. A male predominance was noted in DSP, while a female predominance was noted in DSAP. Itchiness was the most common symptom in both subtypes. Commonly used treatments included corticosteroids and retinoids, both topical and oral. Among the treatments, oral retinoid, diclofenac gel, and cryotherapy showed higher rates of improvement, but none of them yielded complete remission of the skin lesions. In conclusion, DSP and DSAP showed differences in the gender predilection, and both DSP and DSAP had prolonged clinical course and generally refractory to topical or systemic treatments.

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Tumid lupus erythematosus (TLE) as a rare variant of cutaneous lupus erythematosus (CLE) is characterized by edematous, urticarial-like annular papules and plaques. TLE has similar histopathologic findings to CLE such as periadnexal lymphocytic infiltration and interstitial mucin deposition. Although TLE develops on sun-exposed areas at any age, it is rarely distributed along the Blaschko lines and develops in infancy and childhood. Unlike CLE, skin lesion of TLE heals without leaving scarring or dyspigmentation. Here, we report a rare case of unilateral linear TLE in a 4-year-old girl, which was improved by intralesional corticosteroid injection and oral antimalarial drug with leaving postinflammatory hyperpigmentation.

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This study enrolled 25 patients with neurofibromatosis type 1 (NF1) from 10 Chinese pedigrees. Sanger sequencing analysis and multiplex ligation-dependent probe amplification analysis were used to detect mutations and large fragment losses of the NF1 gene. This study identified 10 NF1 mutations, which comprised six novel and four recurrent mutations. Majority of the mutations can lead to termination codon production, which results in the synthesis of the truncated gene product neurofibromin.

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Vohwinkel syndrome is a rare autosomal dominant disease caused by GJB2 mutations. Patients present with sensorineural deafness, pseudoainhum, stellate keratosis on knuckles, and diffuse honeycombed palmoplantar keratoderma. We present a case of a Taiwanese patient with characteristics of Vohwinkel syndrome. A heterozygous missense mutation c.175G > C (p.Gly59Arg) was identified in the GJB2 gene, encoding the gap junction protein connexin 26. Pathogenic GJB2 mutations have been implicated in a spectrum of diseases from nonsyndromic hearing loss to syndromic hearing loss with palmoplantar keratoderma. This report expands the phenotypic spectrum of the p.Gly59Arg mutation to include Vohwinkel syndrome.

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